Peritoneal cancer – Stage 4

What is peritoneal cancer?

Peritoneal cancer means the presence of cancer cells on the peritoneum. The tumor deposits are usually small , the size of rice grains. At times the deposits can be large even upto 5 cm in size.

Peritoneal cancer is primary when the tumro arises from the peritoneum itself (primary peritoneal carcinomatoses). It is secondary when tumor from other sites spreads to the peritoneum. Secondary spread is more commonAlmost any cancer can spread to the peritoneum, but this is more commonly seen in tumors of the abdominal cavity like such as tumors of the stomach, pancreas, large bowel (colon) and tumors of the ovaries and uterus.

What are the most frequent causes of Peritoneal Cancer Spread?

The cancers in which there is a high incidence of peritoneal deposits are colorectal cancer, ovarian cancer, gastric cancer, biliary tract cancers, pancreatic cancer and breast cancer.

When cancer has spread to the peritoneum is it the last stage/stage 4?

Yes spread of cancer to the peritoneum is considered stage 4 in most cancers. In ovarian cancer it is stage 3

Can stage 4 cancer be treated?

All stage 4 cancers are not the same. The outcome depends on the extent of tumor spread. Patients in whom the cancer is spread to only one organ, eg. the liver in colorectal cancer or the peritoneum in ovarian cancer do better than patients in whom more than one organ is involved

Patients with peritoneal implants (tumor deposits) often have cancer spread to the liver or lungs. In some patients however, seeding is limited to the peritoneum. It is for this subgroup of patients that surgical treatment with cytoreductive surgery and HIPEC may be possible.

With this kind of treatment, some patients can have a prolonged life and perform all the activities that people without cancer do.

In a patient with peritoneal cancer, the treatment and outcome depends on

Primary tumor site: patients with colorectal, appendicular, ovarian cancer have a better outcome than other cancers

Extent of metastatic spread: when multiple organs have tumor deposits, cure is usually not possible. Patients with disease limited to the peritoneum can be treated aggressively with a greater chance of cure.

Extent of peritoneal spread: see the section on cytoreductive surgery and HIPEC

“It is known as the “Mother of all Surgeries”. The procedure is of a radical nature and carries high morbidity and mortality. It is relatively new procedure but the technique has been refined over the last few years. The greatest fear stems from ignorance. Many surgeons have just heard about the procedure and have no experience with it. A surgeon who is a specialist in peritoneal surface malignancies knows how best to chose patients for this procedure. Done properly and having a low grade tumor increases your life expectancy by upto 15-20 years.”

Dr Sumaira PervezPakistan

“…my mother aged around 65 years was diagnosed with rare type of disease called pseudomyxoma peritonei in 2009 August
…after a detailed meeting she advised us to go for a surgery ( if possible Hipec) and finally she did the cytoreductive surgery and it was a successful surgery and this time the CEA level also come down to normal range nearly 3.0 , ( In Hyderabad they did 3 surgeries but it remains same around Cea level was 45.0 after surgeries and chemo) ,now more than a year completed and my mother’s health is very good and energetic she is doing all the household works ,shopping and travelling etc and she was on fast whole month of Ramadan…
…what I feel the surgery is more important in these kind of disease and surgeon like Dr Aditi Bhatt did the surgery with patience”